Provider Demographics
NPI:1265615827
Name:RECREATION THERAPY SERVICE
Entity type:Organization
Organization Name:RECREATION THERAPY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECREATION THERAPY SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:GERRON
Authorized Official - Suffix:
Authorized Official - Credentials:CTRS
Authorized Official - Phone:817-570-2230
Mailing Address - Street 1:6000 WESTERN PL
Mailing Address - Street 2:300
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-4607
Mailing Address - Country:US
Mailing Address - Phone:817-570-2230
Mailing Address - Fax:817-570-2231
Practice Address - Street 1:6000 WESTERN PL
Practice Address - Street 2:300
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-4607
Practice Address - Country:US
Practice Address - Phone:817-570-2230
Practice Address - Fax:817-570-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26735261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health